Comparison of Constant and Temperature Dependent Blood Perfusion in Temperature Prediction for Superficial Hyperthermia

The purpose of this study was to determine whether prediction of the 3D temperature profile for superficial hyperthermia using constant blood perfusion model could be matched to one with a temperature dependent blood perfusion. We compared three different constant blood perfusion scenarios with one temperature dependent blood perfusion using a layered model of biological tissue consisting of skin (2 mm), fat (10 mm) and muscle (108 mm). For all four scenarios the maximum temperature of 43 °C was found in the muscle tissue in the close proximity (1 – 3 mm) of fat layer. Cumulative histograms of temperature versus volume were identical for the region of 100x100x40 mm3 under the applicator aperture for the three constant blood perfusion models. For temperature dependent blood perfusion model, 85 % of the studied region was covered with the temperature equal or higher than 40 °C in comparison with 43 % for the constant blood perfusion models. Hence this study demonstrates that constant blood perfusion scenarios cannot be matched to one with a temperature dependent blood perfusion

Standardization of patient modeling in hyperthermia simulation studies: introducing the Erasmus Virtual Patient Repository

Purpose: Thermal dose-effect relations have demonstrated that clinical effectiveness of hyperthermia would benefit from more controlled heating of the tumor. Hyperthermia treatment planning (HTP) is a potent tool to study strategies enabling target conformal heating, but its accuracy is affected by patient modeling approximations. Homogeneous phantoms models are being used that do not match the body shape of patients in treatment position and often have unrealistic target volumes. As a consequence, simulation accuracy is affected, and performance comparisons are difficult. The aim of this study is to provide the first step toward standardization of HTP simulation studies in terms of patient modeling by introducing the Erasmus Virtual Patient Repository (EVPR): a virtual patient model database.Methods: Four patients with a tumor in the head and neck or the pelvis region were selected, and corresponding models were created using a clinical segmentation procedure. Using the Erasmus University Medical Center standard procedure, HTP was applied to these models and compared to HTP for commonly used surrogate models.Results: Although this study was aimed at presenting the EVPR database, our study illustrates that there is a non-negligible difference in the predicted SAR patterns between patient models and homogeneous phantom-based surrogate models. We further demonstrate the dif

Feasibility and relevance of discrete vasculature modeling in routine hyperthermia treatment planning

Purpose: To investigate the effect of patient specific vessel cooling on head and neck hyperthermia treatment planning (HTP). Methods and materials: Twelve patients undergoing radiotherapy were scanned using computed tomography (CT), magnetic resonance imaging (MRI) and contrast enhanced MR angiography (CEMRA). 3D patient models were constructed using the CT and MRI data. The arterial vessel tree was constructed from the MRA images using the ‘graph-cut’ method, combining information from Frangi vesselness filtering and region growing, and the results were validated against manually placed markers in/outside the vessels. Patient specific HTP was performed and the change in thermal distribution prediction caused by arterial cooling was evaluated by adding discrete vasculature (DIVA) modeling to the Pennes bioheat equation (PBHE). Results: Inclusion of arterial cooling showed a relevant impact, i.e., DIVA modeling predicts a decreased treatment quality by on average 0.19 °C (T90), 0.32 °C (T50) and 0.35 °C (T20) that is robust against variations in the inflow blood rate (|ΔT| 0.5 °C) were observed. Conclusion: Addition of patient-specific DIVA into the thermal modeling can significantly change predicted treatment quality. In cases where clinically detectable vessels pass the heated region, we advise to perform DIVA modeling

Hyperthermia treatment planning guided applicator selection for sub-superficial head and neck tumors heating

textabstractPurpose: In this study, we investigated the differences in hyperthermia treatment (HT) quality between treatments applied with different hyperthermia systems for sub-superficial tumours in the head and neck (H&N) region. Materials and methods: In 24 patients, with a clinical target volume (CTV) extending up to 6 cm from the surface, we retrospectively analysed the predicted HT quality achievable by two planar applicator arrays or one phased-array hyperthermia system. Hereto, we calculated and compared the specific absorption rate (SAR) and temperature distribution coverage of the CTV and gross tumour volume (GTV) for the Lucite cone applicator (LCA: planar), current sheet applicator (CSA: planar) and the HYPERcollar (phased-array). Results: The HYPERcollar provides better SAR coverage than planar applicators if the target region is fully enclosed by its applicator frame. For targets extending outside the HYPERcollar frame, suffic

Comparison of Constant and Temperature Dependent Blood Perfusion in Temperature Prediction for Superficial Hyperthermia

The purpose of this study was to determine whether prediction of the 3D temperature profile for superficial hyperthermia using constant blood perfusion model could be matched to one with a temperature dependent blood perfusion. We compared three different constant blood perfusion scenarios with one temperature dependent blood perfusion using a layered model of biological tissue consisting of skin (2 mm), fat (10 mm) and muscle (108 mm). For all four scenarios the maximum temperature of 43 °C was found in the muscle tissue in the close proximity (1 – 3 mm) of fat layer. Cumulative histograms of temperature versus volume were identical for the region of 100x100x40 mm3 under the applicator aperture for the three constant blood perfusion models. For temperature dependent blood perfusion model, 85 % of the studied region was covered with the temperature equal or higher than 40 °C in comparison with 43 % for the constant blood perfusion models. Hence this study demonstrates that constant blood perfusion scenarios cannot be matched to one with a temperature dependent blood perfusion

The potential of constrained SAR focusing for hyperthermia treatment planning: analysis for the head & neck region

Clinical trials have shown that hyperthermia is a potent adjuvant to conventional cancer treatments, but the temperatures currently achieved in the clinic are still suboptimal. Hyperthermia treatment planning simulations have potential to improve the heating profile of phased-array applicators. An important open challenge is the development of an effective optimization procedure that enables uniform heating of the target region while keeping temperature below a threshold in healthy tissues. In this work, we analyzed the effectiveness and efficiency of a recently proposed optimization approach, i.e. focusing via constrained power optimization (FOCO), using 3D simulations of twelve clinical patient specific models. FOCO performance was compared against a clinically used particle swarm based optimization approach. Evaluation metrics were target coverage at the 25% iso-SAR level, target hotspot quotient, median target temperature (T50) and computational requirements. Our results show that, on average, constrained power focusing performs slightly better than the clinical benchmark (ΔT50 = +0.05 °C), but outperforms this clinical benchmark for large target volumes (>40 cm 3 , Δ T50 = +0.39 °C). In addition, the results are achieved in a shorter time (-44%) and are repeatable because the approach is formulated as a convex optimization problem

Reconstruction of applicator positions from multiple-view images for accurate superficial hyperthermia treatment planning

In the current clinical practice, prior to superficial hyperthermia treatments (HT), temperature probes are placed in tissue to document a thermal dose. To investigate whether the painful procedure of catheter placement can be replaced by superficial HT planning, we study if the specific absorption rate (SAR) coverage is predictive for treatment outcome. An absolute requirement for such a study is the accurate reconstruction of the applicator setup. The purpose of this study was to investigate the feasibility of the applicator setup reconstruction from multiple-view images. The accuracy of the multiple-view reconstruction method has been assessed for two experimental setups using six lucite cone applicators (LCAs) representing the largest array applied at our clinic and also the most difficult scenario for the reconstruction. For the two experimental setups and 112 distances, the mean difference between photogrametry reconstructed and manually measured distances was 0.25 ± 0.79mm (mean±1 standard deviation). By a parameter study of translation T (mm) and rotation R (°) of LCAs, we showed that these inaccuracies are clinically acceptable, i.e. they are either from ±1.02 mm error in translation or ±0.48° in rotation, or combinations expressed by 4.35R 2 + 0.97T 2 = 1. We anticipate that such small errors will not have a relevant influence on the SAR distribution in the treated region. The clinical applicability of the procedure is shown on a patient with a breast cancer recurrence treated with reirradiation plus superficial hyperthermia using the six-LCA array. The total reconstruction procedure of six LCAs from a set of ten photos currently takes around 1.5 h. We conclude that the reconstruction of superficial HT setup from multiple-view images is feasible and only minor errors are found that will have a negligible influence on treatment planning quality

MR temperature monitoring for MR-RF hyperthermia:a systems-level approach

\u3cp\u3eNon-invasive high-resolution 3D MR temperature maps can significantly improve dosimetry during thermal dose delivery in hyperthermic oncology. However, with long treatment times, system- and patient-induced drift in the B\u3csub\u3e0\u3c/sub\u3e main magnetic field of the MR scanner may adversely impact the accuracy of temperature measurements. In addition, the insertion of conventional RF hyperthermia apparatus into an MR scanner obstructs the use of commercial MR receive coil arrays in the scanner bore. If they had been available for use, such receive arrays could potentially increase imaging signal-to-noise ratio (SNR) and/or temporal resolution of MR thermometry. Here, we describe a systems-level perspective of improving temperature monitoring in MR-RF hyperthermia. This approach includes a previously developed fat-referenced MR thermometry technique, and a dual-function coil array design that addresses the limitations in imaging SNR and temporal resolution that are inherent in conventional MR-guided RF hyperthermia systems. We will also discuss system-level considerations that can adversely impact MRT measurements when integrating a RF hyperthermia sub-system with a MRI system.\u3c/p\u3